Online citations, reference lists, and bibliographies.
← Back to Search

Is There Evidence That Palliative Care Teams Alter End-of-life Experiences Of Patients And Their Caregivers?

I. Higginson, I. Finlay, D. Goodwin, K. Hood, A. Edwards, A. Cook, H. Douglas, C. Normand
Published 2003 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy
Share
Palliative care provision varies widely, and the effectiveness of palliative and hospice care teams (PCHCT) is unproven. To determine the effect of PCHCT, 10 electronic databases (to 2000), 4 relevant journals, associated reference lists, and the grey literature were searched. All PCHCT evaluations were included. Anecdotal and case reports were excluded. Forty-four studies evaluated PCHCT provision. Teams were home care (22), hospital-based (9), combined home/hospital care (4), inpatient units (3), and integrated teams (6). Studies were mostly Grade II or III quality. Funnel plots indicated slight publication bias. Meta-regression (26 studies) found slight positive effect, of approximately 0.1, of PCHCTs on patient outcomes, independent of team make-up, patient diagnosis, country, or study design. Meta-analysis (19 studies) demonstrated small benefit on patients' pain (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.23-0.64), other symptoms (OR: 0.51, CI: 0.30-0.88), and a non-significant trend towards benefits for satisfaction, and therapeutic interventions. Data regarding home deaths were equivocal. Meta-synthesis (all studies) found wide variations in the type of service delivered by each team; there was no discernible difference in outcomes between city, urban, and rural areas. Evidence of benefit was strongest for home care. Only one study provided full economic cost-benefit evaluation. This is the first study to quantitatively demonstrate benefit from PCHCTs. Such comparisons were limited by the quality of the research.
This paper references
10.1136/BMJ.320.7228.129
A good death
R. Smith (2000)
[Hospital care versus home nursing: on the quality of life of terminal tumor patients].
A. Dessloch (1992)
10.1136/bmj.309.6956.719
Systematic Reviews: Some examples
P. Knipschild (1994)
10.1016/0885-3924(91)90070-K
Argentina's WHO Cancer Pain Relief Program: a patient care model.
R. Wenk (1991)
10.1097/00005650-198802000-00008
Comparing the Quality of Death for Hospice and Non-Hospice Cancer Patients
K. Wallston (1988)
10.1016/0277-9536(91)90054-G
A comparison of hospice and conventional care.
C. Seale (1991)
10.1177/014107689909200525
Palliative medicine as a specialty
S. Fordham (1999)
10.1016/0021-9681(86)90102-5
An overview of National Hospice Study findings.
D. S. Greer (1986)
10.1177/104973239600600407
Meta-Synthesis of Qualitative Findings
L. Jensen (1996)
10.1001/JAMA.1995.03530240045039
The Cochrane Collaboration. Preparing, maintaining, and disseminating systematic reviews of the effects of health care.
L. Bero (1995)
10.1016/0197-2456(94)00031-W
Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists.
D. Moher (1995)
The impact of hospice services on the quality of life of primary caregivers.
S. McMillan (1994)
10.1016/0885-3924(88)90119-4
Argentina's who cancer pain relief program
R. Wenk (1988)
1986 International Symposium on Pain Control
J. G. Hannington-Kiff (1988)
The year before death
C. Seale (1994)
10.1136/bmj.305.6865.1317
Randomised controlled trial of effects of coordinating care for terminally ill cancer patients.
J. Addington-hall (1992)
10.1136/sbmj.00032
A good death
R. Smith (2000)
10.1016/S0015-0282(16)56450-4
Cigarette smoking and sperm density: a meta-analysis.
M. Vine (1994)
10.1016/0895-4356(88)90164-3
Day hospital as an alternative to inpatient care for cancer patients: a random assignment trial.
V. Mor (1988)
10.1136/bmj.309.6954.597
Systematic Reviews: Rationale for systematic reviews
C. Mulrow (1994)
10.1016/0885-3924(95)00166-2
Improving analgesic prescribing in a general teaching hospital.
R. McQuillan (1996)
10.1001/JAMA.1985.03350420095025
Hospice Effectiveness in Controlling Pain
R. Kane (1985)
10.1136/bmj.318.7200.1730
β Blockade after myocardial infarction: systematic review and meta regression analysis
N. Freemantle (1999)
10.1097/00005650-198503000-00001
Hospice Role in Alleviating the Emotional Stress of Terminal Patients and Their Families
R. Kane (1985)
10.1177/026921639500900205
Assessing the effectiveness of a hospital palliative care team
J. Ellershaw (1995)
10.1016/S0140-6736(84)91349-7
A RANDOMISED CONTROLLED TRIAL OF HOSPICE CARE
RobertL. Kane (1984)
10.1136/bmj.309.6965.1351
Systematic Review: Why sources of heterogeneity in meta-analysis should be investigated
S. Thompson (1994)
10.3109/13561829309014988
Teams and terminal cancer care at home: Do patients and carers benefit?
R. H. Jones (1993)
10.1016/0021-9681(86)90106-2
Last days: a study of the quality of life of terminally ill cancer patients.
J. Morris (1986)
10.1016/S0895-4356(98)00131-0
The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus.
A. Verhagen (1998)
10.1016/S0140-6736(85)91917-8
TERMINAL CARE: HOME, HOSPITAL, OR HOSPICE?
C. Parkes (1985)
10.1191/026921699677461429
The impact of different models of specialist palliative care on patients' quality of life: a systematic literature review
C. Salisbury (1999)
10.1016/S0140-6736(73)92900-0
Letter: Treatment of amoebic colitis.
Pittman Fe (1973)
10.1177/026921639400800308
The impact on community palliative care services of a hospital palliative care team
M. Bennett (1994)
10.1136/pgmj.56.660.685
Terminal care: evaluation of an advisory domiciliary service at St Christopher's Hospice.
C. Parkes (1980)
10.1056/NEJM199304153281506
Trends in Medicare payments in the last year of life.
J. Lubitz (1993)
10.2105/AJPH.75.2.134
A randomized controlled study of a home health care team.
J. G. Zimmer (1985)
10.1891/9780826171122.0025
Meta-synthesis of qualitative analyses of caring: defining a therapeutic model of nursing.
G. Sherwood (1997)
10.1097/00005650-198705000-00002
Effects of an Expanding Home Care Program for the Terminally III
J. Mccusker (1987)
10.1136/BMJ.306.6878.648-C
Death from cancer at home.
K. A. Milligan (1993)
10.1093/OXFORDJOURNALS.ANNONC.A057794
Quality-of-life assessment during a palliative care programme.
V. Ventafridda (1990)
10.1002/1097-0142(19890915)64:6<1375::AID-CNCR2820640634>3.0.CO;2-6
A randomized clinical trial of home nursing care for lung cancer patients
R. McCorkle (1989)
10.1136/bmj.322.7298.1357
Are quality of life measures patient centred?
A. Carr (2001)
10.1001/JAMA.283.15.2008
Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.
D. Stroup (2000)
Meta-analysis of Observational Studies in Epidemiology
D. F. Stroup (2000)
10.1136/bmj.312.7040.1215
Why we need observational studies to evaluate the effectiveness of health care
N. Black (1996)
10.1093/OXFORDJOURNALS.PUBMED.A024608
Outcome measures in palliative care for advanced cancer patients: a review.
J. Hearn (1997)
10.1093/OXFORDJOURNALS.PUBMED.A042688
Effectiveness of two palliative support teams.
I. Higginson (1992)
10.1177/026921638900300208
Evaluation of a new hospice: the relief of symptoms in cancer patients in the first year
M. B. Mclllmurray (1989)
10.1016/S0885-3924(01)00315-3
Efficiency of searching the grey literature in palliative care.
A. Cook (2001)
10.1016/0021-9681(86)90103-7
An alternative in terminal care: results of the National Hospice Study.
D. S. Greer (1986)
10.1191/026921600701536200
A randomized controlled trial of a hospital at home service for the terminally ill
G. Grande (2000)
10.1136/BMJ.306.6872.249
Death from cancer at home: the carers' perspective.
R. Jones (1993)
10.1016/S0885-3924(01)00406-7
Do hospital-based palliative teams improve care for patients or families at the end of life?
I. Higginson (2002)
10.1136/bmj.320.7234.569
The role of patient care teams in chronic disease management
E. Wagner (2000)
10.1097/00007632-200010150-00024
Behavioral Treatment for Chronic Low Back Pain: A Systematic Review Within the Framework of the Cochrane Back Review Group
M. V. van Tulder (2001)
10.1136/bmj.315.7109.629
Bias in meta-analysis detected by a simple, graphical test
M. Egger (1997)
10.1136/bmj.315.7109.672
How to read a paper: Papers that summarise other papers (systematic reviews and meta-analyses)
T. Greenhalgh (1997)
10.1111/j.1532-5415.1984.tb02023.x
Effects of a Physician‐led Home Care Team on Terminal Care
J. G. Zimmer (1984)
10.1037//0022-006X.62.1.157
Dying in palliative care units and in hospital: a comparison of the quality of life of terminal cancer patients.
L. Viney (1994)
10.1136/pgmj.60.700.120
'Hospice' versus 'hospital' care--re-evaluation after 10 years as seen by surviving spouses.
C. Parkes (1984)
10.1016/0021-9681(86)90105-0
Analgesic use in terminal cancer patients: report from the National Hospice Study.
R. Goldberg (1986)
10.1177/0272989X0002000305
The Effectiveness of One-to-one Risk-communication Interventions in Health Care
A. Edwards (2000)
10.1136/bmj.315.7122.1610
Meta-analysis: Beyond the grand mean?
G. Smith (1997)
10.1177/030089168907500622
Comparison of Home and Hospital Care of Advanced Cancer Patients
V. Ventafridda (1989)
10.1016/0885-3924(93)90082-7
Attitudes of surviving relatives to terminal care in South Australia.
M. Wakefield (1993)
10.1136/bmj.313.7068.1291
Conservative management of mechanical neck pain: systematic overview and meta-analysis
P. Aker (1996)
10.1177/026921638900300207
The cost-effectiveness of the Citymission Hospice Programme, Melbourne
D. Dunt (1989)
10.1177/026921639601000307
The Provision of a Palliative Care Service in a Teaching Hospital and Subsequent Evaluation of That Service
R. McQuillan (1996)
10.1136/pgmj.55.646.517
Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part I. Views of surviving spouse on effects of the service on the patient.
C. Parkes (1979)
10.1177/030089168507100506
The Importance of a Home Care Program for Patients with Advanced Cancer Pain
V. Ventafridda (1985)
10.1177/014107688908200507
Measuring Symptoms in Terminal Cancer: Are Pain and Dyspnoea Controlled?
I. Higginson (1989)
10.1002/HEC.4730030308
The UK Cochrane Centre and the NHS Centre for reviews and dissemination: respective roles within the information systems strategy of the NHS R&D programme, coordination and principles underlying collaboration.
T. Sheldon (1994)
10.2307/3550586
Methods for the Economic Evaluation of Health Care Programmes, Second Edition
M. Drummond (1987)
10.1191/026921600668340746
Palliative care needs of hospital inpatients
P. Edmonds (2000)
10.1136/bmj.319.7223.1472
Does hospital at home for palliative care facilitate death at home? Randomised controlled trial
G. Grande (1999)
10.5860/choice.26-1552
The Hospice experiment
V. Mor (1988)
10.1016/0021-9681(86)90104-9
The effect of treatment setting and patient characteristics on pain in terminal cancer patients: a report from the National Hospice Study.
J. Morris (1986)
10.1136/adc.77.4.347
Measuring quality of life
M. Jenney (1997)
10.2307/3350356
"The high cost of dying" revisited.
A. Scitovsky (1994)
10.1136/BMJ.320.7234.581
beta Blockade after myocardial infarction. Beta blockers have key role in reducing morbidity and mortality after infarction.
S. Nuttall (2000)
10.1136/PGMJ.55.646.523
Terminal care: evaluation of in-patient service at St Christopher's Hospice. Part II. Self assessments of effects of the service on surviving spouses.
C. Parkes (1979)
10.1177/016327878100400305
Evaluation of a Hospice Program:
S. Silver (1981)
10.1111/J.1749-6632.1993.TB26345.X
The Cochrane Collaboration: Preparing, Maintaining, and Disseminating Systematic Reviews of the Effects of Health Care
I. Chalmers (1993)
10.1001/JAMA.282.24.2358
The need for perspective in evidence-based medicine.
S. Woolf (1999)
10.1177/026921639400800302
Can home care maintain an acceptable quality of life for patients with terminal cancer and their relatives?
J. Hinton (1994)
10.1016/S0885-3924(96)00320-X
Outcome evaluation in a home palliative care service.
C. Peruselli (1997)
10.1016/S0140-6736(79)90467-7
COMPARISON OF PLACES AND POLICIES FOR TERMINAL CARE
J. Hinton (1979)
10.1136/bmj.322.7289.763
The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials
D. Lawlor (2001)
10.1191/026921698677822456
Do hospital palliative care teams improve symptom control? Use of a modified STAS as an evaluation tool
P. Edmonds (1998)
10.1300/J027V06N01_09
An examination of the effect of reimbursement and organizational structure on the allocation of hospice staff time.
V. Mor (1985)
10.1016/S0885-3924(97)00006-7
A multicenter evaluation of cancer pain control by palliative care teams.
I. Higginson (1997)
10.1191/026921698671336362
Evaluation of a hospital-based palliative support service with particular regard to financial outcome measures
B. Axelsson (1998)
10.1016/0021-9681(86)90156-6
The role of hospice in reducing the impact of bereavement.
R. Kane (1986)
10.1177/026921639601000210
A randomized controlled trial of the cost-effectiveness of a district co-ordinating service for terminally ill cancer patients
J. Raftery (1996)
Comparative cost analysis of home and hospital treatment.
V. Vinciguerra (1986)
10.1136/bmj.322.7291.924/a
Atypical antipsychotics in the treatment of schizophrenia
R. Kerwin (2001)
10.1097/00005650-198005000-00009
Home and hospital cost of terminal illness.
B. Bloom (1980)
[Palliative care unit in a district hospital: analysis of 2 years of experience. Multidisciplinary palliative care teams].
André Zwahlen (1991)
10.1136/bmj.321.7273.1371
Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis
J. Geddes (2000)
10.1136/bmj.309.6965.1340
Evaluation of a palliative care service: problems and pitfalls
I. McWhinney (1994)
10.1001/JAMA.280.3.278
Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals.
A. Jadad (1998)
Quality of life of primary caregivers of hospice patients with cancer.
S. McMillan (1996)
10.1016/0885-3924(89)90003-1
Influence of the pain and symptom control team (PSCT) on the patterns of treatment of pain and other symptoms in a cancer center.
E. Bruera (1989)
10.1097/00024382-199512000-00014
How to Read a Paper
T. Greenhalgh (1999)
10.1177/014107689809101105
Palliative medicine: is it really specialist territory?
S. Fordham (1998)
10.1093/FAMPRA/10.4.364
The Cochrane Collaboration in Primary Health Care.
C. Silagy (1993)
10.1136/JECH.45.3.254
The Natural History of a Survey
D. A. Jones (1991)
10.1097/00005650-198307000-00006
UCLA Hospice Evaluation Study: Methodology and Instrumentation
J. Wales (1983)
Meta-analysis and beyond: applying secondary research methods to primary care
T. Greenhalgh (1998)
10.1097/00002030-199211000-00023
An economic evaluation of home‐care assistance for AIDS patients: a pilot study in a town in northern Italy
A. Tramarin (1992)
The high cost of dying
R. Harmer (1963)
10.1097/00002820-199402000-00006
A study of quality of life of hospice patients on admission and at week 3
S. McMillan (1994)
10.1200/JCO.1986.4.10.1521
A comparative assessment of home versus hospital comprehensive treatment for advanced cancer patients.
V. Vinciguerra (1986)
A comparison of hospice vs conventional care of the terminally ill cancer patient.
V. Mor (1990)
10.1191/026921698676629560
Quality of life of cancer patients and their spouses in palliative home care
B. Axelsson (1998)
A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill.
S. Hughes (1992)



This paper is referenced by
10.21037/apm.2017.07.07
Clinical hypnosis, mindfulness and spirituality in palliative care.
Consuelo C. Casula (2018)
Surgical Pall iative Care : Recent Trends and Developments
G. Dunn ()
Effect of Communication Skills Training for Generalist Palliative Care Providers on Patient-Reported Outcomes and Clinician Behaviors: A Systematic Review and Meta-analysis. Journal of Pain and Symptom Management, 54(3), 404-416.e5. DOI: 10.1016/j.jpainsymman.2017.04.007
L. Selman ()
Care Interventions for Patients with Heart Failure : A Systematic Review and Meta-Analysis
M. Diop (2016)
10.1016/j.jpainsymman.2017.04.017
Factors Associated With the Use of U.S. Community-Based Palliative Care for Children With Life-Limiting or Life-Threatening Illnesses and Their Families: An Integrative Review.
Jackelyn Y. Boyden (2018)
Current and future needs for hospice care: an evidence-based report
N. Calanzani (2013)
10.5694/j.1326-5377.2003.tb05576.x
Home‐based support for palliative care families: challenges and recommendations
P. Hudson (2003)
10.1177/0269216307085182
Populations who die without specialist palliative care: does lower uptake equate with unmet need?
D. Currow (2008)
10.1378/CHEST.07-1392
Palliative care consultation, quality-of-life measurements, and bereavement for end-of-life care in patients with lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition).
J. Griffin (2007)
10.1176/APPI.AJP.163.7.1208
Family focused grief therapy: a randomized, controlled trial in palliative care and bereavement.
D. Kissane (2006)
10.1089/JPM.2006.9.731
Health care policy issues in end-of-life care.
K. Lorenz (2006)
10.1007/s00520-008-0424-2
Comfort in the last 2 weeks of life: relationship to accessing palliative care services
D. Currow (2008)
10.1016/j.jpainsymman.2008.12.005
Prediction of survival time in advanced cancer: a prognostic scale for Chinese patients.
Zhou Ling-jun (2009)
10.1177/0733464817732511
Quality of Life for Late Life Patients: Mixed-Methods Evaluation of a Whole-Person Approach for Patients With Chronic Illnesses
Tetyana P Shippee (2019)
10.1097/NJH.0b013e318279f4ce
Patient Outcomes and Satisfaction With Care Following Palliative Care Consultation
S. Parker (2013)
Dying at home
Irene J. Higginson (2013)
10.1089/tmj.2011.0061
A systematic review of the evidence base for telehospice.
D. Oliver (2012)
10.1016/j.ejca.2010.01.035
PRISMA: a pan-European co-ordinating action to advance the science in end-of-life cancer care.
R. Harding (2010)
10.3109/13561820.2010.515427
Can sharing stories change practice? A qualitative study of an interprofessional narrative-based palliative care course
Charles Campion-Smith (2011)
10.1016/j.jpainsymman.2013.01.010
The Selection and Use of Outcome Measures in Palliative and End-of-Life Care Research: The MORECare International Consensus Workshop
C. Evans (2013)
10.1089/JPM.2016.0330
Palliative Care Interventions for Patients with Heart Failure: A Systematic Review and Meta-Analysis.
M. Diop (2017)
10.1007/s00520-017-3895-1
The impact of specialized palliative care on cancer patients’ health-related quality of life: a systematic review and meta-analysis
A. Kassianos (2017)
10.1007/978-3-319-77740-5_58
Palliative Care and Neurodegenerative Diseases
David Oliver (2019)
10.1016/B978-1-4377-1619-1.00038-X
Chapter 38 – The Interdisciplinary Team
J. Paice (2011)
10.1089/JPM.2005.8.13
Palliative care outcomes research: the next steps.
R. Morrison (2005)
10.7249/TR642
The potential cost savings of greater use of home- and hospice- based end of life care in England
Evi Hatziandreu (2008)
10.1371/journal.pone.0138773
The Impact of Hospice Care on Survival and Healthcare Costs for Patients with Lung Cancer: A National Longitudinal Population-Based Study in Taiwan
Jui-Kun Chiang (2015)
10.1177/1049909113491455
Palliative Care Consultation Trajectories
E. Kozlov (2014)
What are the challenges of applying the Liverpool Care Pathway for the dying
Kathryn Lunn (2012)
10.6004/JNCCN.2016.0009
Palliative Care Version 1.2016.
Michael Levy (2016)
10.1016/j.jpainsymman.2015.02.023
Cost Savings Associated With an Inpatient Palliative Care Unit: Results From the First Two Years.
Jeremy D. Nathaniel (2015)
10.1097/PPO.0b013e3181f2894c
The Oncologist's Role in Care of the Dying Cancer Patient
J. Lacey (2010)
See more
Semantic Scholar Logo Some data provided by SemanticScholar